Pregnancy as a Window to Future Cardiovascular Health

描述（由申请人提供）：最近的流行病学研究表明，患有不良妊娠结局（APO）（例如先兆子痫）的女性随后患心血管疾病的风险增加。然而，缺乏前瞻性数据来阐明不良妊娠结局与随后的心血管疾病之间的确切关系。为了解决这一关键的知识差距，NHLBI 发布了一项 RFA，研究将怀孕作为未来孕产妇健康的窗口。在这个提案中，一个拥有多元化人才的多学科团队 专业知识将确定产后两年 APO 与心血管疾病风险 (CVDR) 标志物之间的关系。这个多中心小组将利用 10,000 名参与 NICHD 资助的未产妇妊娠结果研究：监测准妈妈 (nuMoM2b) 的未生育妇女组成的种族、种族、社会经济和地理多样化队列。 拟议的研究具有高度杠杆作用，利用了母研究中开发的广泛且独特的数据库和组织库，其中对未产妇在怀孕过程中进行评估，以研究 APO 的机制和预测。通过前瞻性数据收集、临床评估和超声评估以及标准化定义的使用，参加 nuMoM2b 队列的女性的表型非常好。人口统计、社会心理、饮食、生理和结果信息由经过培训的人员通过产妇访谈、自填问卷、临床测量、超声波和病历提取来收集。收集并储存怀孕期间的母血、尿液和宫颈阴道液样本以及分娩时的脐带血和胎盘样本。所有女性均需完成两份睡眠调查问卷，并招募超过 3,600 名女性在怀孕期间两次进行客观的夜间睡眠研究。 参与 nuMoM2b 母体研究的女性将在产后两到三年接受 CVDR 证据评估，包括睡眠呼吸障碍 (SDB)。随后怀孕时的 APO 也将被评估。这些研究将描述 APO 和 CVDR 之间的关系，确定预示后续 CVDR 的首次妊娠概况，确定首次妊娠期间的 SDB 与后续 CVDR 之间的关联，并确定介导首次和后续妊娠中 CVDR 和 APO 之间关联的可修改因素。这将有助于制定策略来改变这些 CVDR 因素并改善患有 APO 的妇女的健康。 相关性：NICHD 目前正在进行一项大型研究，寻找可识别风险的测试 首次怀孕的女性出现怀孕问题。在这项新研究中，同样的女性将在产后大约两年后再次接受检查，看看怀孕问题的女性是否有心脏病的早期迹象。这项后续研究的信息将用于利用她们在怀孕期间的经历来改善妇女的健康。

DESCRIPTION (provided by applicant): Recent epidemiologic studies suggest that women with adverse pregnancy outcomes (APOs), such as preeclampsia, are at increased risk for subsequent cardiovascular diseases. However, prospective data to elucidate the precise relationship between adverse pregnancy outcomes and subsequent cardiovascular disease are lacking. To address this critical knowledge gap, the NHLBI issued a RFA to study pregnancy as a window to future maternal health. In this proposal, a multidisciplinary team with diverse talents and expertise will define the relationship between APOs and markers of cardiovascular disease risk (CVDR) at two years after delivery. This multicenter group will utilize an ethnically, raciall, socioeconomically and geographically diverse cohort of 10,000 nulliparous women enrolled in the NICHD-funded Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). The proposed studies are highly leveraged, utilizing the extensive and unique database and tissue bank developed in the parent study in which nulliparous women are evaluated over the course of pregnancy to study the mechanisms for and prediction of APOs. Women enrolled in the nuMoM2b cohort are extremely well phenotyped through prospective data collection, clinical evaluations, and ultrasound assessments, as well as through the use of standardized definitions. Demographic, psychosocial, dietary, physiologic, and outcome information is collected through maternal interviews, self-administered questionnaires, clinical measurements, ultrasounds, and medical record abstraction by trained personnel. Samples of maternal blood, urine, and cervico-vaginal fluid over pregnancy and cord blood and placenta at delivery are collected and banked. All women complete two sleep questionnaires and over 3,600 are recruited to perform objective overnight sleep studies at two times during pregnancy. Women participating in the nuMoM2b parent study will be assessed for evidence of CVDR, including sleep disordered breathing (SDB), at two to three years postpartum. APOs in subsequent pregnancies also will be assessed. These studies will characterize the relationship between APOs and CVDR, identify first pregnancy profiles that portend subsequent CVDR, determine associations between SDB during the first pregnancy and subsequent CVDR, and identify modifiable factors that mediate the associations between CVDR and APOs in the first and subsequent pregnancy. This will allow for the development of strategies to modify these CVDR factors and to improve the health of women suffering APOs. Relevance: NICHD is currently conducting a large study that looks for tests to identify the risk of developing pregnancy problems in women who are pregnant for the first time. In this new study, the same women will be tested again at approximately 2 years after they give birth to see if there are early signs of heart disease in those who had problem pregnancies. Information from this follow-up study will be used to improve the health of women using their experiences during pregnancy.